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A 47-year-old man who had been admitted to the hospital with gastroenteritis was found to have abnormalities on a chest radiograph. He had a 25-pack-year smoking history and had worked in a quarry for more than 30 years. He had no respiratory symptoms, and the vital signs and physical examination were normal. The chest radiograph showed diffuse nodular opacities (Panel A). Computed tomography of the chest revealed lung nodules in a perilymphatic distribution (Panel B), as well as matted mediastinal lymphadenopathy with calcifications. Spirometry showed a restrictive ventilatory pattern without evidence of obstruction. A bronchoscopy with bronchoalveolar lavage and a transbronchial lung cryobiopsy were performed. Tests for infectious diseases, including tuberculosis, were negative. Histopathological analysis of a biopsy specimen under polarized light revealed abundant silica crystals (Panel C). A diagnosis of chronic silicosis — an occupational pneumoconiosis caused by the inhalation of crystalline silicon dioxide — was made. The condition afflicts workers in occupations such as coal mining, sandblasting, and quarrying, as in this case. Smoking-cessation counseling was provided, and nicotine replacement therapy was initiated. A report was filed with an occupational safety office. The patient was provided with a respirator and resumed working in the quarry owing to his difficulty with finding other work. At a 6-month follow-up visit, he remained asymptomatic.
Shan Kai Ing, M.D. , and Sze Shyang Kho, M.D.Author Info & Affiliations
Published May 11, 2024
N Engl J Med 2024;390: e46
DOI: 10.1056/NEJMicm2312247
VOL. 390 NO. 19


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